Performance Improvement Plan:

Graduate Nurse Residency Program

Lorraine A. BabcockUniversity of Central Florida

Significance

• Nursing leadership wants to avoid RN turnover– Definition: employee termination or transfer from their

initial position within 1 year– Due to insufficient staffing, high stress, low job

satisfaction • Projected nursing shortage

– 1.2 million open jobs by 2020 – Due to retirement & the need to grow the nursing

workforce to meet increased access to care• New graduate RNs at the bedside

– Lack competence– Have low levels of confidence– Experience little or no transition into professional

nursing practice– Have high tendency for turnover

Baseline Data• Literature search keywords

– Graduate nurses– New nurses– Residency– Turnover– Retention

• Appropriate articles designated level IV, level VI, & level VII were analyzed

• Findings: residency programs decreased turnover or increased retention by helping assist the GN to a productive role

• Limitations of evidence– Lack of randomization– Large numbers of variables in the data collection– No consideration of economic factors

Potential Strategies

• Evaluate research studies – Statistical significance, and– Program success

• Decreased turnover• Increased retention

• Model program components after organizations deemed successful

Culture & Change Management Strategies

• The CNO champions for support– Senior leadership– Nursing leadership– Clinical nurse educators– Human resources

• Staffing specialists (hiring process)• Marketing (promote residency program

using social media, the internet, & job fairs)

Plan Design• PLAN (6 months)

– Gather data from other residency programs– Meet with key stakeholders

• Complete a needs assessment • Evaluate resources needed & barriers to overcome (FISHBONE diagram)

– PEOPLE (nursing leadership, clinical nurse educators, staffing specialists, mentors, preceptors, simulation center educator)

– EQUIPMENT (simulation center)– MANAGEMENT (program content; requirements of GNs, mentors, & preceptors)– PROCESSES (evaluate & update if needed)– ENVIRONMENT (clinical training combined with socialization)– REGULATION (develop policies re: hiring process; criteria for selection of GNs,

preceptors, mentors, & educators)

• DO (1 year)– Cohort 1 completes the residency program

• STUDY (at baseline, 6 months, & 1 year)– Collect data from surveys & administrative statistics– If successful at 6 months, request approval for additional residencies

• ACT (ongoing)– Evaluate & modify program components as necessary

Cost & Potential Savings

• Estimated cost of residency – $17,000 (non-critical care)– $31,000 (critical care)

• Other cost considerations– FTE of clinical educators– Simulation center operating costs

• Estimated savings due to reduced turnover– 1.5 to 2 times the salary of the RN

Potential Outcomes Evaluation

• Measures of success– Administrative data

• Collected up to 2 years• Turnover • Retention rates

– Surveys of graduate nurses• Online• Anonymous; no identifiers• At baseline, 6 months, & 1 year

References• Nursing Shortage. (2014, January). Retrieved from American Association of Colleges

of Nursing: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage• The Future of Nursing: Leading Change, Advancing Health. (2014). Retrieved from

The National Acadamies Press: http://books.nap.edu/openbook.php?record_id=12956• Anderson, G., Hair, C., & Todero, C. (2012, July-August). Nurse residency programs: an

evidence-based review of theory, process, and outcomes. Journal of Professional Nursing, 28(4), 203-212.

• Bratt, M. M., & Felzer, H. M. (2012, May/June). Predictors of new graduate nurses' organizational commitment during a nurse residency program. Journal for Nurses in Staff Development, 28(3), 108-119.

• Friedman, M. I., Cooper, A. H., Click, E., & Fitzpatrick, J. J. (2011, January-February). Specialized new graduate RN critical care orientation: retention and financial impact. Nursing Economics, 29(1), 7-14.

• Halfer, D., Graf, E., & Sullivan, C. (2008, July-August). The organizational impact of a new graduate pediatric nurse mentoring program. Nursing Economics, 26(4), 243-249.

• Hillman, L., & Foster, R. R. (2011). The impact of a nursing transitions programme on retention and cost savings. Journal of Nursing Management, 19, 50-56.

• Kowalski, S., & Cross, C. (2010, Jan). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18(1), 96-104.

• Kowalski, S., & Cross, C. L. (2010). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18, 96-104.

References • Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing &

Healthcare: A Guide to Best Practice (2nd ed.). Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins.

• Newhouse, R. P., Hoffman, J. J., Suflita, J., & Hairston, D. P. (2007, January-March). Evaluating an innovative program to improve new nurse graduate socialization into the acute healthcare setting. Nursing Administration Quarterly, 31(1), 50-60.

• Olson-Sitki, K., Wendler, M. C., & Forbes, G. (2012, July/August). Evaluating the impact of a nurse residency program for newly graduated registered nurses. Journal for Nurses in Staff Development, 28(4), 156-162.

• Pine, R., & Tart, K. (2007, January-February). Return on investment: benefits and challenges of a baccalaureate nurse residency program. Nursing Economics, 25(1), 13-18, 39.

• Sherwood, G., & Barnsteiner, J. (2012). Quality and Safety in Nursing: A Competency Approach to Improving Outcomes. West Sussex, England: Wiley-Blackwell.

• Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012, Jul-Aug). New graduate nurse residency program: a cost-benefit analysis based on turnover and contract labor usage. Nursing Economics, 30(4), 207-214.

• Ulrich, B., Krozek, C., Early, S., Ashlock, C. H., Africa, L. M., & Carman, M. L. (2010, November-December). Improving retention, confidence, and competence of new graduate nurses: results from a 10-year longitudinal database. Nursing Economics, 28(6), 363-375.

• Welding, N. M. (2011, January-February). Creating a nursing residency: decrease turnover and increase clinical competence . MedSurg Nursing, 20(1), 37-40.